Provider Demographics
NPI:1811014707
Name:SCHUBERT & KRACK, D.S.S., P.A.
Entity Type:Organization
Organization Name:SCHUBERT & KRACK, D.S.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-335-7771
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:21027-0020
Mailing Address - Country:US
Mailing Address - Phone:410-335-7771
Mailing Address - Fax:
Practice Address - Street 1:12412 EASTERN AVE.
Practice Address - Street 2:
Practice Address - City:CHASE
Practice Address - State:MD
Practice Address - Zip Code:21027-0020
Practice Address - Country:US
Practice Address - Phone:410-335-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD67231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty